How to Start a Community Healthy Weight Clinic
Posted February 17, 2015 by Cindy Hutter
|Certified Chef Ana Jaramillo conducts a cooking demonstration at the Holyoke Health Center Healthy Weight Clinic.
For nearly two decades, Vincent Biggs, MD, has been helping families in Holyoke, Mass., get healthier. Perhaps these last seven years, however, have had the biggest impact. In 2008, Biggs ventured beyond the traditional medical practice model and started a healthy weight clinic, located at the Holyoke Health Center, in the Pediatrics Department. As a result, hundreds of families in this culturally and economically diverse town have benefited from nutritional counseling, physical activity recommendations and referrals to community resources.
The healthy weight clinic has seen most participating families make significant lifestyle changes. Patients are eating more fruits and vegetables, drinking fewer sugar-sweetened beverages, getting more physical activity and viewing less screen time. As a result, over a third of the clinic’s patients have decreased their body mass index (BMI). In a recent 5-month group session nearly 50 percent of the participants decreased their BMI.
Biggs, now a faculty member for NICHQ’s Mass in Motion Kids Learning Collaborative, an initiative that promotes opportunities for healthy eating and active living, is documenting his expertise in creating and running the Holyoke clinic in a Healthy Weight Clinic Guide, which is expected to publish this spring.
We recently sat down with Biggs to get an advance lesson on some of the top tips he has to offer.
Tell us about your clinic. How is it run?
We offer our healthy weight clinic two afternoons a week. We give families their choice of individual or group visits. Regardless of their choice, I meet with all families individually and conduct a medical assessment. I learn if there are any co-morbidities related to weight, such as high cholesterol or sleep apnea. Any necessary labs or studies are ordered. During the individual visits the dietitian has the family do a 24-hour diet recall (reporting what they ate) and nutrition evaluation and provides specific nutritional education. We both set goals with the patient or family that can be worked on until the next visit in a month. The case manager is available to refer patients to community based programs or services as needed.
The group visits typically include five to eight families and provide a more collaborative approach to learning about healthy habits. The families themselves share their insight with the group, which is a powerful tool for behavior change. Currently, Ana Jaramillo, a certified chef, is doing cooking demonstrations in each group visit and discusses topics such as preparing healthy meals and snacks, using alternative ingredients to make meals healthier, portion size, the value of fruits and vegetables and limiting sugar-sweetened beverages. We see families generally once a month for six visits in both settings. Depending on their readiness, we will refer them back to their primary care physician or continue to see them.
What is a good staffing model for a healthy weight clinic?
We have a pediatrician, a dietitian, a case manager and medical assistant. We can comfortably see 10-15 families in the five total hours we are open each week (3 hours individual, 2 hours group). Yesica Rodriguez, our current case manager, plays the important role of connecting families to different community groups, like referrals to the Greater Holyoke YMCA that gives families access to a reduced membership rate.
How do you get families to come to the clinic?
As a program of the Holyoke Health Center, we see patients from both the Holyoke and Chicopee health center sites, which have over 20 providers and many see children and adolescents. Holyoke Health Center providers refer their patients to the healthy weight clinic. A referral can be made through our referral module directly to our case manager that maintains the clinic schedule. We do have flyers to promote the clinic throughout the health center and incentives to attend the visits are helpful.
What’s the first step when a new family comes to the healthy weight clinic?
We’ve developed an assessment tool that we call the Healthy Living Plan (HLP), which is a healthy weight plan. The family completes the HLP on arrival to the visit which includes historical information about a family’s lifestyle such as physical activity, nutrition and sleep habits. During the visit we spend a lot of time talking with families about the HLP and then using motivational interviewing techniques we support families to set a few achievable healthy living goals. On future visits, we’re checking in on those goals and supporting changes as needed.
What are some challenges to running a healthy weight clinic?
From the clinic management side, staffing in a community health center setting can be a challenge. There is a lot of turnover, so retraining and maintaining consistency of staff over time has been a challenge for us. From the client management side, attendance can be a challenge. Traditionally, these types of clinics have a higher no-show rate than other visits at the health center, so it’s important to find ways to keep families motivated and incentivized to attend. We have had good luck with linking visits to the clinic to our local farmers market with vouchers and incentives such as passes to our local amusement park.
What do you think is critical to a healthy weight clinic’s success?
Being organized and having clearly defined roles for the team members is very helpful. Being collaborative in your approach with all members of the team actively involved in clinic improvements is important. It is also very helpful to be part of some structured process, like a collaborative or learning community, at least at the beginning. Starting a clinic on your own is very doable, but harder than with a group of others with the same mission.
Definitely connect with others that are doing this type of work in your local community. The Holyoke Health Center is the lead organization in a city wide imitative entitled “Let’s Move Holyoke 5210.” This initiative was developed as part of NICHQ’s Collaborate for Healthy Weight project in 2012 and continues as a multi-sector healthy lifestyle promotion initiative that includes the medical community, schools, early childhood education, WIC, City of Holyoke, Mass in Motion and YMCA. Everything we do in the healthy weight clinic, we try to link to that community piece. It has helped with buy-in and motivation from families to feel that they are part of a larger community-wide effort.
How can other practices interested in providing a healthy weight clinic get started?
A first step is identifying other people who have interest in your practice or community—ideally a pediatric provider, someone who can do nutrition assessment and education and someone, like a case manager, who can support linking families to activities and organizations in your community. I had an incredible team to start our clinic, which included dietitian Kathy Berdecia, RD, case manager Nancy Rubert and medical assistant Maritza Rodriguez. The Holyoke Health Center initiated the startup funding for the clinic through grant support and now the clinic is sustained via visit reimbursements.
Because these are medical visits, they are reimbursable in most states, which make them very sustainable. Other resources are available through grants as well. A good place to start for funding is with the insurers in your area, including Medicaid managed care organizations, and community benefits offices of your local hospital. Both of these groups offer services and financial support to local community organizations. Hospitals are required to offer these services to maintain their non-profit status from the federal government so they are often very interested in helping out.
Lastly, remember there are many resources available to do this type of work so you don’t have to reinvent the wheel. My hope is the soon to be released Healthy Weight Clinic Guide will serve that purpose for any clinic interested in starting a healthy weight clinic.
To learn more about NICHQ's obesity work, visit http://obesity.nichq.org